glup montecchio diagnosi urodinamica semplificata-torino_vignoli
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- 1. UDS ASSISTANT A Software for Urodynamic Semi-Automated Diagnosis
2. Why a Software ?
- In recent years the role of urodynamics in the assessment of lower urinary tract dysfunctions has become contentious
- Often the literature is contradictory and lacks adequate evidence, rendering meaningful conclusions difficult
- In an attempt to overcome these shortcomings the International Continence Society (ICS) has published a number of standardization reports to guide clinical and research activity .
3. ECG Automated Diagnosis
- Electrical spikes & segments
- Pressure spikes & segments
4. Algorithms Sources-I
- An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction
- Bernard T. Haylen
- Dirk de Ridder
- Robert M. Freeman
- Steven E. Swift
- Bary Berghmans
- Joseph Lee
- Ash Monga
- Eckhard Petri
- Diaa E. Rizk
- Peter K. Sand
- Gabriel N. Schaer
- Neurourol Urodyn 2010
5. Algorithms Sources -II 6. Display 7. Single vs multichannel UDS 8. Quality control procedure before Pressure/Flow study 9. Neurogenic patient 10. Final report ( neurogenic patient ) 11. Algorithms Rationale 12. Flowmetry Analysis Siroky - male < 50 yrs Bristol - male > 50 yrs Liverpool - female 13. Male Free Flow Predictive Value
- Unobstructed Qmax >15ml/s
- ( Warning: 50% may be obstructed High Pressure / High Flow)
- Equivocal Qmax10 to15 ml/s
- ( Warning:70% may be obstructed ; 30% may be unobstructed DU
- Obstructed Qmax 200ml check upper tract for dilation
16. Filling Phase (Cystometry) Analysis
- Normal tracing
- Overactive Bladder
- ( clinically< 15 cm H20 significant contractions)
- Hypersensitive Bladder
- ( early sensation < 100mlwhithout contractions )
- Low Compliance Bladder
- ( > 10 cmH20 at cystometric capacity)
- Yukio Homma ,2007
17. PRESSURE/ FLOW ANALYSIS-Male ICS Nomograms
- BOO Index: pdetMax-2Qmax
- >40obstructed
- 20-40equivocal
- 90 cm H20Hypermobility
- between 60 and 90 cm H20Equivocal
- 50 yrs 63. LiverpoolNomogram Female 64. Male Free Flowmetry
Predictive Value
- Question :
- Should all patients with LUTShave pressure-flow studies?
65. DisplaySample 66. Cistometry Display 67. Diagnosis 68. Urethral Function Analysis 69. MalePressure / FlowDisplay 70. FemalePressure / FlowDisplay 71. DisplaySample 72. Neurologic Patient Display 73. Clinical Examples 74.
- Case 1 :42 y.o. active tennis
- player.Two vaginal deliveries.
- She needs pads during matches.
75. Case 2 : 72 y.o. women.Mixed incontinence. Previous hysterectomy & ant. and post. repair. TVT failed 76. Case 4 :62 y.o. man with urgency,frequency,nocturia 77. Conclusions
- The purposeof the software is just to give some skill in interpreting the findings
- The software doesnt substitute in any way the clinical experience
- To get the best from a urodynamic investigation, it is necessary to understand the patients complaint and distinguish clinically significant findings from equipment malfunction.
- The software may ensure consistency between all who carry out urodynamics
- Once validated , it may be an instrument for the assessment of clinical reliabilty ofcurrent urodynamic tests
78. Future Software Developments
- Pediatric Urodynamics
- Options for Treatment
79. Urodynamics in Pediatric Age
- Adjustments for :
- Flowmetry( Liverpool Nomogram )
- Bladder Capacity ( Age x 30 + 30)
- 6 years old boy : 6x30+30 = 210 ml
80. Options for Treatment
- Sources
- EAU Guidelines
- AUA Guidelines
- ICIGuidelines
- Cochrane Reviews
- NICE Reviews
- High IF articles ,ecc..
81. 82. 83. 84. 85. 86.
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